Nationwide Cooperation Research Articles

From local networks to national reform? Programmatic groups in the regionalization of German health policy

AbstractBefore policy reform initiatives reach the agenda of national decision makers, such initiatives often start at a small‐scale, local level. The Programmatic Action Framework (PAF) emphasizes the importance of biographical connections to understand how a group of policy actors forms, and how it develops programs that may lead to decade‐long policy change. This article applies the PAF to study the emergence of a programmatic group behind initiatives on regionalization in German health policy through discourse analysis and expert interviews. The study contributes to understanding social networks behind policy programs and social‐psychological, partly informal drivers of policy change. The results show that many PAF conditions have already been met in the German health policy subsystem. We describe a network of policy actors with local and organizational drivers that has led to nationwide cooperation on regionalization.Related ArticlesCaliskan, Cantay. 2020. “The Influence of Elite Networks on Green Policy Making.” Politics & Policy 48(6): 1104–37. https://doi.org/10.1111/polp.12382.Petridou, Evangelia, Per Becker, and Jörgen Sparf. “Policy Entrepreneurs in Public Administration: A Social Network Analysis.” Politics & Policy 49(2): 414–45. https://doi.org/10.1111/polp.12400.Svallfors, Stefan, Erica Falkenström, Corrie Hammar, and Anna T. Höglund. 2022. “Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance.” Politics & Policy 50(3): 580–97. https://doi.org/10.1111/polp.12462.

The Beginnings of the Cooperation of Free Royal Towns in the Kingdom of Hungary in the Sixteenth and Seventeenth Centuries

The study presents the possibilities and framework for cooperation between towns in Hungary through the operation of the Town League of Upper Hungary. The cooperation of towns in the Kingdom of Hungary happened primarily through regional relations. At first, the basis for cooperation was provided by common economic interests, but this area broadened considerably in the sixteenth and seventeenth centuries. After the battle of Mohács (1526), the towns of Hungary became full members of the Hungarian Estates. The Kingdom of Hungary, which was part of the Habsburg Monarchy, gained considerable autonomy in internal politics. This was based on a compromise with the Habsburg rulers to ensure protection against the Ottoman Empire. The free royal towns were the least influential members of this country that had strong Estates. Nevertheless, cooperation between the towns became nationwide. The diets provided the forum for all free royal towns in the country to represent their common interests in a coordinated way. There are traces of this nationwide cooperation as early as the mid-sixteenth century, but it was from the early seventeenth century that it was the strongest. The reason was that in those decades state taxes were becoming heavier and more burdensome for towns. This nationwide cooperation was not only manifested in the field of taxation, but from the first quarter of the seventeenth century onwards, it increasingly extended to religious matters. In the background, there was the increasing recatholization of the Habsburg Monarchy. In this special matter, close links were forged also with the otherwise strongly anti-urban lower nobility.

"The education is a mirror of where palliative care stands in Israel today": An exploration of palliative care undergraduate education at medical schools in Israel.

Israel serves as a case study for understanding the importance of undergraduate palliative care (PC) education in implementing, developing, and enabling access to palliative care services. This article presents the findings collected from the five medical schools. This qualitative study supported by a survey explores and describes the state of undergraduate PC education at medical schools in Israel. The survey included questions on voluntary and mandatory courses, allocation of different course models, teaching methods, time frame, content, institutions involved, and examinations. Semi-structured interviews with teaching faculty were conducted at the same locations. Eleven expert interviews and five surveys demonstrate that PC is taught as a mandatory subject at only two out of the five Israeli universities. To enhance PC in Israel, it needs to become a mandatory subject for all undergraduate medical students. To teach communication, cultural safety, and other basic competencies, new interactive teaching forms need to be developed and adapted. In this regard, nationwide cooperation is proposed. An exchange between medical schools and university clinics is seen as beneficial. The new generation of students is open to PC philosophy and multidimensional care provision but resources to support their growth as professionals and people remain limited. This study underlines the importance of teaching in PC at medical schools. Undergraduate education is a central measure of PC status and should be used as such worldwide. The improvement of the teaching situation would automatically lead to a better practical implementation for the benefit of people. Medical schools should cooperate, as the formation of expertise exchange across medical schools would automatically lead to better PC education.

A paramilitary retrieval team for accidental hypothermia. Insights gained from a simple classification with advanced treatment over 16 years in Denmark

AimTo present the results from 16 years of nationwide cooperation between the Danish Airforce Search and Rescue Service and a Tertiary Heart Centre for the classification and treatment of accidental hypothermia. MethodsA mobile extracorporeal membrane oxygenation (ECMO) retrieval team was developed and could be contacted for nationwide advice and if indicated retrieval and/or treatment of patients by means of ambulance and/or helicopter.Accidental hypothermia was classified as mild, moderate, and severe, corresponding to awake, unconscious, and lifeless. The exact temperature was not considered relevant in the primary assessment.The mild group was treated with blankets and minimal invasive with warm i.v. infusions. The moderate group was primarily treated with an ABC approach, and if circulation was unstable due to arrhythmias or bleeding, invasive warming was performed with pleural lavage under ECMO preparedness. The severe group was treated with CPR followed by ECMO. All patients were examined for underlying disorders. ResultsThe team was involved in 204 patients, but for 47 patients treatment was stopped as they were considered beyond therapeutic reach, leaving 157 treated patients with 108 (69%) survivors. Among 54 ECMO patients, 21 (39%) survived to hospital discharge. ConclusionsWe successfully implemented a simplified classification of accidental hypothermia and initiated a nationwide cooperation for retrieval and/or treatment of accidental hypothermic patients.

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

Retroperitoneale Fibrose

Retroperitoneal fibrosis (RPF) is characterised by inflammatory fibrotic processes affecting the retroperitoneal structures. Its prevalence of 1 - 2/200,000 makes it a rare disease. To date, there are no guidelines for the diagnosis of or therapy for the disease. If untreated, the disease may be fatal. In 2006, the Department of Urology of the HELIOS Klinikum Wuppertal undertook to establish a nationwide patient registry, which would facilitate prospective therapy trials and the drafting of recommendations for diagnostic procedures. The pathogenesis of the disease is still unclear. Since some RPF-patients present with associated autoimmune diseases, autoimmune processes are suspected to play a role in causing the disease. The presence of autoantibodies and histological similarities with vasculitis support this hypothesis. Following initial general symptoms, patients display localised symptoms (flank pain, leg oedema, abdominal discomfort), caused by the displacing effect of the fibrotic plaques. Laboratory tests show elevated ESR and C-reactive protein and in some cases a moderate anaemia. Histological examinations should be undertaken to rule out the presence of malignant tumours. Radiological diagnostics (excretory urography, CT, MRI) show a retroperitoneal mass which blocks, compresses and displaces, completely or in part, the large vessels and the ureter. Initial therapy aims at restoring the function of the affected hollow organs through the application of (ureteric) stents, followed by immunosuppressive therapy. If drug therapy is unsuccessful, surgical procedures will follow to protect the ureter from compression. In some cases, ureteral replacement or an autotransplant of the kidney may be necessary. Life-long observation of the patients is necessary, as the disease may be chronic and relapsing. Interdisciplinary and nationwide cooperation is of crucial importance to further investigate this disease.

Phenotypic features, androgen receptor binding, and mutational analysis in 278 clinical cases reported as androgen insensitivity syndrome.

Androgen insensitivity syndrome (AIS) is the most common single entity that results in male under-masculinization, but large cohort studies of AIS have rarely been performed. Over the last decade, nationwide cooperation between pediatric endocrinologists in the United Kingdom has allowed the creation of a database of cases of intersex and ambiguous genitalia where detailed clinical information on every notified case has been collected via a questionnaire. Among the 816 entries recorded by January 1999, there were 105 clinically diagnosed cases of complete AIS (CAIS) and 173 cases of partial AIS (PAIS). A masculinization score was devised by scoring the external phenotype, and a score of 12 represented normal masculinization. Androgen receptor (AR) binding was determined by studying binding capacity (Bmax) and receptor affinity (K(d)), and cases were classified as either zero, abnormal, or normal binding. Mutation screening of all eight exons of the AR gene was performed by single-strand conformational polymorphism analysis, followed by direct DNA sequencing. All cases of PAIS presented within the first month of birth. The median age at presentation of children with CAIS was 1 yr (P10,P90: 0.1,10.4). The testes were palpable in the labioscrotal folds or the inguinal region in 77% and 41% of cases of CAIS and PAIS, respectively. There was marked overlap between the masculinization score of those children with PAIS reared as girls [2.5(P10,P90:1, 6)] and those reared as boys [3(P10,P90:2, 7.5)]. Gonadectomy was performed prepubertally in 66% and postpubertally in 29% of the cases of CAIS. The median age of the latter group was older at 14 yr (P10,P90:0.1,18). No cases of malignancy or carcinoma in situ were reported in the 121 cases of AIS where histology results were available. Biochemical endocrine investigations were reported to have been performed in a greater number of cases of PAIS than CAIS (98% vs. 48%). AR binding was abnormal in 44 of 51 (86%) and 40 of 113 (35%) cases of CAIS and PAIS, respectively. Zero binding was encountered in 29 of 43 (67%) and 1 of 55 (2%) cases of CAIS and PAIS, respectively. Mutational analysis of the AR gene, performed in 102 index cases was positive in 57 of 69 (83%) cases of CAIS and 12 of 43 (28%) cases of PAIS. In 24 of these cases, the mutation identified was novel. The mutations in PAIS cases were all missense, whereas in CAIS the mutations were more diverse. AR binding was only normal in 3 of 69 mutation-positive cases. In the PAIS group, mutation-positive cases had a significantly higher Kd and Bmax compared to the mutation negative cases. The clinical diagnosis of AIS can be confirmed in a significant number of cases by a combination of androgen-binding studies and mutational analysis. There is some correlation between the phenotypic features and the abnormalities discovered on mutational analysis of the AR gene, but there is a need to improve this further by developing optimal bioassays of AR function. The phenotypic heterogeneity among clinically diagnosed cases of AIS emphasizes the need for appropriate comprehensive evaluation of male under-masculinization.

Interrupted moult of adult Willow Warblers Phylloscopus trochilus during autumn migration through Sweden

Among passerines a complete moult is carried out annually after breeding in the summer season or, in some long-distance migrants, after autumn migration in the winter season. A few species, such as the Willow Warbler Phylloscopus trochilus, show two complete annual moults. It is often observed that among Willow Warblers on autumn migration passage a few individuals retain one or more old secondaries, hence the moult after breeding has been interrupted. We hypothesise that the frequency of birds showing moult interruption should increase with increasing breeding latitude due to the shorter time available for breeding and moult towards north. Further, we expected a higher incidence of moult interruption in females compared with males because females presumably are more involved in breeding activities. These hypotheses were explored with data on adult Willow Warblers collected at Swedish bird observatories during a nation-wide co-operation project concerning the migration of the Willow Warbler. We found a positive correlation between the proportion of Willow Warblers with unmoulted secondaries and latitude. The proportion of females with moult interruption was higher than in males, and among birds with remaining old secondaries females had more unmoulted feathers than males. We found a rather high proportion of birds with interrupted moult at southern observatories, which we speculate may be associated with birds laying second clutches in some years.

Opportunities for Nationwide Cooperation

Opportunities for Nationwide Cooperation